Labour - What to Expect

A mucous show

A mucous show is also known as your “plug". It is usually a blood stained or pinkish-streaked, jelly-like substance which can occur anytime from 37 weeks onwards. You do not need to do anything and we don’t need to know at this stage. If however, you notice fresh red blood loss you should contact us.

Contractions

Contractions can be confusing when they first start, in early labour (also known as latent labour) they can sometimes come every few minutes. These are often variable in strength and length. They can happen for a few hours and then go away. There is no time limit on how long early labour can take but it can last for a number of days. It is important at this stage to take care of yourself. Resting, eating and drinking whenever you feel that you can. You can call your chosen birth centre if you feel you need reassurance during this stage.

There will be a change in the strength and length of contractions as they develop into a regular pattern and will be different from what you might have already felt. As a guide, when true labour is underway, you will be having at least one painful, regular contraction every five minutes, lasting around a minute. As contractions become more intense it will become increasingly difficult to focus on anything else, this is established labour.

Your waters (membranes) may break

This is when the bag of fluid (known as liquor) which surrounds your baby breaks and the fluid escapes without you having any control over it. The colour of the liquid is usually clear and you may feel very wet or just a slight dampness. Once your waters have broken, you will continue to leak liquid up until the birth. It does not necessarily mean you will go into labour straightaway because waters can break before labour begins, during labour itself, or not until your baby is ready to be born.

If you think your waters have broken it is important to ring us as we would like to see you.

If you think your waters have broken before contractions have started we will ask you to come in so we can confirm if your waters have broken, and to discuss what your options are if there are no signs of labour. Please start to wear a sanitary towel (preferably not a slimline one) so you can see the colour of any fluid you lose. If all is well you will be encouraged to return home again for up to 24 hours until labour establishes.

Sometimes waters break before labour starts. This happens in about one in 20 pregnancies and is known as pre-labour spontaneous rupture of the membranes. When this happens about nine out of ten women will go into labour naturally within 24 hours.

We advise you to stay at home as long as you can so that nothing interferes with your labour becoming established. If your waters break before you go into labour, we will ask you to take and record your temperature four hourly whilst awake at home, as risk of infection increases once the sterile waters surrounding your baby have ruptured.

How long will labour take?

Every labour is different. It is normal for the first part to take a few days of irregular pains similar to period type pains. Try not to clock watch or wear yourself out. Rest, eat nourishing food and have plenty of drinks preferably isotonic drinks or water. As a general guide, with your first baby it can take 12-14 hours once your labour has become properly established.

When to come in (contact your community midwife if you are booked for a home birth.)

Contact your community midwife if you are booked for a home birth.

It is important that you call your chosen birth area to let them know that you would like to come in. This allows you to have a discussion with the midwife and inform her of what has been happening. This also allows us to ensure that we have someone ready to welcome you when you arrive. You and your birth partner(s) will be shown to a birth room. Your midwife will make you comfortable, find out from you what has been happening so far and how your health and pregnancy have been. Your abdomen will be felt to see how your baby is lying and your babies heartbeat will be listened to. You may be offered an internal examination to see if your cervix (the neck of the womb) is starting to open yet.

If you are not yet in established labour, you may be advised to return home – this is the best place to be in the early stages of labour. Your midwife will discuss with you when to return and ways of coping at home. Don’t be disappointed if we recommend that you go home again if your labour isn’t established, this is very common and a normal process of labour as evidence shows home is the best place to be in early labour. Being in an unfamiliar environment in eary labour can cause contractions to stop.

If your labour is well established, your midwife will discuss your preferences for your labour and birth with you. We encourage you to be as upright and mobile as possible, and mats and birth balls are available – please ask if these are not in your room already. Soft lighting and your favourite music (you are welcome to bring your choice of music with you) may help you to relax. If your baby needs to be continuously monitored we offer telemetry (mobile monitoring) which enables us to continuously monitor your baby’s heartbeat while you are up and walking/active.

Prior to the onset of labour

Contractions - Painless practice or “Braxton Hicks” contractions are common.

Meals - Eat as normal

Monitoring - Your baby’s pattern of movement should remain as it has been. Any decrease in your baby’s movements must be discussed with a midwife and not ignored.

Support - You should be thinking about who you would like to be your birthing partners, ensure you have contact numbers for your community midwife or your place of birth.

Vaginal loss - Pregnancy often increases the amount of clear vaginal discharge.

Dilatation - Your cervix is closed and about two cm in thickness.

How you may feel - Expectant, excited, uncertain and anxious.

Very early labour

Expected length - Can last several days.

Contractions – Contractions feel uncomfortable but are not yet regular.

Meals - Small, light meals containing carbohydrates prepare the body well. Keep well hydrated.

Monitoring - Continue to be aware of your baby’s movements (as above).

Activity - A walk or stretching can help you relax. Try to rest and sleep as well.

Support - You may not want to be on your own, a birth partner (doesn’t have to be your chosen support for the birth) can hold you, rub your back and be reassuring.

Vaginal loss - You may pass a “show”, the plug of mucus is released from your cervix, this can be streaked with blood. Your waters may break.

Dilatation - The cervix thins out.

Pain relief - Bathing, mobilising, a Tens machine, massage, relaxing music and Paracetamol (no more than eight in 24 hours) can really help.

How you may feel - Excited but try to pace yourself.

Active labour - 1st stage

Expected length - 1st baby from six - 20 hours. 2nd baby onwards from two - ten hours.

Contractions - Contractions are coming regularly about every five minutes (or more frequently) and lasting 20-60 seconds.

Meals - Lots of fluids help, you may not feel like eating much.

Monitoring - The midwife will listen to the baby’s heartbeat every 15 minutes, your blood pressure and temperature will be taken every four hours and your pulse every 30 minutes.

Activity - Remaining upright and active can mean less need for pain relief and a shorter 1st stage of labour.

Support - You are advised to contact a midwife at this stage. A midwife will care for you throughout labour.

Vaginal loss - Your midwife will monitor the vaginal loss, your “waters” may break.

Dilatation - The cervix gradually dilates up to about ten cm. This is called fully dilated.

Pain relief - Being active and having a bath/shower can help and have no side effects. Pain killing drugs are available, your midwife will discuss them.

How you may feel - At the end of the 1st stage, you might become a bit “tetchy” and feel you cannot cope. This is a good sign - you are nearly there.

Active labour - 2nd stage

Expected length - 1st baby from one-three hours. 2nd baby onwards from ten minutes - one hour.

Contractions - Contractions are very strong and close together with strong urges to push down.

Meals - Sips of fluid can help your mouth from drying out.

Monitoring - The midwife will listen to the baby’s heartbeat every 5 minutes.

Activity - Movement and changing position can help.

Support - Your midwife and birth partner’s will encourage you with your pushing.

Vaginal loss - Your waters may break, the midwife will monitor the vaginal loss.

Dilatation - The cervix is fully dilated.

How you may feel - Very focused requiring all your efforts, can feel overwhelming. Your midwife will support you with this.

Active labour - 3rd stage

Expected length - 20 mins - one hour or five-15 minutes with an injection.

Contractions - You may feel a strong urge to push your placenta out.

Activity - Being upright can help your body expel the placenta.

Vaginal loss - A small gush of blood is usually passed before the placenta comes out.

How you may feel - An enormous relief, you will be holding and maybe feeding your baby and occupied for this part.

After the birth

Monitoring - Your temperature, pulse and blood pressure will be taken. Your baby will be weighed and its temperature taken.

Activity - You have earned a good rest!

Support - At home: the midwife will leave only when you are happy to be left. In hospital your post birth care may be provided by a maternity care assistant under a nurses supervision.

Vaginal loss - The vaginal loss can be like a heavy period for a few days.

Dilatation - The cervix closes after the placenta and membranes are delivered.

Pain relief - If you need stitches, local anaesthetic will be used to take away the discomfort.

How you may feel - Very tired but totally fulfilled, congratulations!